Krakor Endoscopic Mitral Valve Surgery

Handbook of Minimal-invasive Cardiac Surgery
1. Auflage 2011
ISBN: 978-3-11-025445-7
Verlag: De Gruyter
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 145 Seiten

The minimally-invasive or endoscopic mitral valve surgery is one of the most attractive and most interesting areas of the modern heart surgery. The book describes first all practical steps necessary in a clinic from the idea of the introduction of the minimally-invasive mitral valve surgery up to practical realization of the operation program. The initial explanation of organizational and financial aspects allows an exact resource planning and protects against wrong expectations and failures. An extensive and detailed representation of the reconstruction technologies possible today as well as the specific features of her endoscopic application allow quick learning of the surgical technology. Numerous tips and tricks and informative pictures of the most frequent findings and the accompanying reconstruction technologies underline the practical orientation of the book.

Zielgruppe

Specialists in Cardiac Surgery, Cardiac Surgery Residents, Interventional Cardiologists

Autoren/Hrsg.

Krakor, Ralf

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Kardiologie, Angiologie, Phlebologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Herz- & Thoraxchirurgie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Chirurgie Minimalinvasive Chirurgie, Laserchirurgie, Laparoskopie

Inhaltsverzeichnis

1;Contents;6
2;Preface;10
3;1 Introduction;12
3.1;1.1 General thoughts on endoscopic surgery;12
3.1.1;1.1.1 The philosophy;12
3.1.1.1;The ideas behind it;12
3.1.1.2;Complexity;13
3.1.1.3;Experience;13
3.1.1.4;Valve repair – frequency of valve replacements;14
3.1.2;1.1.2 The team;14
3.1.3;1.1.3 Holding out;15
3.2;1.2 How to start an endoscopic program;16
3.2.1;1.2.1 Starting conditions for endoscopic mitral valve surgery;17
3.2.2;1.2.2 Patient-related arguments;18
3.2.2.1;Prognosis;18
3.2.2.2;Need for blood transfusion;20
3.2.2.3;Wound-healing disturbances;20
3.2.2.4;Cosmetic reason;21
3.2.3;1.2.3 Hospital-related arguments;22
3.2.3.1;Marketing;22
3.2.3.2;Economic reasons;22
3.2.4;1.2.4 Patient selection;24
3.2.5;1.2.5 Teaching course;26
3.2.6;1.2.6 Starter kit for endoscopic mitral valve surgery;26
3.2.7;1.2.7 Overview;27
4;2 Anesthesiology and pain management;30
4.1;2.1 Intubation and ventilation;30
4.2;2.2 Pain management;30
5;3 Technical prerequisites;34
5.1;3.1 Cannulas and extracorporeal circulation;34
5.1.1;3.1.1 Arterial cannulas (retrograde perfusion);34
5.1.2;3.1.2 Arterial cannulas (antegrade perfusion);35
5.1.3;3.1.3 Venous cannulas;36
5.1.4;3.1.4 Extracorporeal circulation;39
5.2;3.2 Accessories;39
5.2.1;3.2.1 Soft-tissue retractor;39
5.2.2;3.2.2 Arms for videoscopic camera and atrial retractor;40
5.3;3.3 Instruments;41
5.3.1;3.3.1 Atrial hook;44
5.4;3.4 Sutures;44
6;4 Preparations;48
6.1;4.1 Arterial and venous cannulation;48
6.1.1;4.1.1 Femoral vessel cannulation after preparation;48
6.1.2;4.1.2 Direct cannulation of the ascending aorta;51
6.2;4.2 Mini-thoracotomy;54
6.3;4.3 Ports;58
6.4;4.4 Videoscopy;59
6.4.1;4.4.1 The wrinkle;60
6.4.2;4.4.2 The diameter;61
6.4.3;4.4.3 The monitor picture;61
6.4.4;4.4.4 Additional helpful details;61
6.5;4.5 Cardioplegia;62
6.5.1;4.5.1 Use of cardioplegia;62
6.5.2;4.5.2 Operations under fibrillation;66
6.6;4.6 Aortic clamping;67
6.6.1;4.6.1 Endoclamping;67
6.6.2;4.6.2 The Chitwood technique;68
6.6.3;4.6.3 Complications;70
7;5 Valve repair techniques;72
7.1;5.1 Quadrangular resection;72
7.1.1;5.1.1 Pathological anatomy;72
7.1.2;5.1.2 Theoretical remarks;73
7.1.3;5.1.3 Practical realization;73
7.1.3.1;Identifying the prolapse;73
7.1.3.2;Cutting out of the prolapse;74
7.1.3.3;Narrowing of the annulus;76
7.1.3.4;Closure of the gap;77
7.2;5.2 Triangular resection;79
7.2.1;5.2.1 Pathological anatomy;79
7.2.2;5.2.2 Theoretical remarks;80
7.2.3;5.2.3 Practical realization;80
7.2.3.1;Identifying the prolapse;80
7.2.3.2;Cutting out the prolapse;81
7.2.3.3;Narrowing of the annulus;81
7.2.3.4;Closure of the gap;82
7.3;5.3 Sliding technique;82
7.3.1;5.3.1 Pathological anatomy;82
7.3.2;5.3.2 Theoretical remarks;83
7.3.3;5.3.3 Practical realization;84
7.3.3.1;Identifying the diseased parts;84
7.3.3.2;Cutting out of diseased part(s);85
7.3.3.3;Retiring the leaflet;87
7.3.3.4;Narrowing of the annulus;88
7.3.3.5;Sliding and refixation;88
7.4;5.4 Neochords - preformed loops;89
7.4.1;5.4.1 Pathological anatomy;90
7.4.2;5.4.2 Theoretical remarks;92
7.4.3;5.4.3 Practical realization;94
7.4.3.1;Identifying the diseased parts;94
7.4.3.2;Measurement of the chordae length;94
7.4.3.3;Implantation of preformed loops;96
7.5;5.5 Neochords – flexible length;96
7.5.1;5.5.1 Pathological anatomy;97
7.5.2;5.5.2 Theoretical remarks;97
7.5.3;5.5.3 Practical realization;98
7.5.3.1;Identifying the diseased parts;98
7.5.3.2;Measurement of the chorda length;98
7.5.3.3;Implantation of flexible chords;98
7.6;5.6 Artificial rings;102
7.6.1;5.6.1 Theoretical remarks;102
7.6.2;5.6.2 Implantation technique;103
7.6.3;5.6.3 Complications;105
7.7;5.7 Emergency exit;106
7.7.1;5.7.1 Theoretical remarks;106
7.7.2;5.7.2 Practical performing;107
8;6 Tips and tricks;110
8.1;6.1 Perfusion’s challenge;110
8.2;6.2 Diaphragm's obesity;111
8.3;6.3 View’s hurdles;112
8.4;6.4 Instruments’ versatility;114
8.5;6.5 The knot pusher’s independent existence;117
8.6;6.6 Managing bleeding;120
8.6.1;6.6.1 Bleeding of ascending aorta;120
8.6.2;6.6.2 Bleeding of the left atrial incision;121
8.6.3;6.6.3 Bleeding of the left atrial appendage;121
8.6.4;6.6.4 Injury of the right pulmonary main stem;121
8.6.5;6.6.5 Injury of the right mammary artery;122
8.6.6;6.6.6 Bleeding of the intercostal artery;122
9;7 Additional procedures;124
9.1;7.1 Left atrial ablation;124
9.1.1;7.1.1 Endocardial ablation;124
9.1.2;7.1.2 Epicardial ablation - pulmonary veins clamp technique;126
9.1.3;7.1.3 Epicardial ablation - box lesion with Cobra Adhere XL®;127
9.1.3.1;Technical background of Cobra Adhere XL®;128
9.1.3.2;Heat sink effect;129
9.1.3.3;Practical use of Cobra Adhere XL®;130
9.2;7.2 Management of the left atrial appendage;132
9.3;7.3 Tricuspid valve repair;136
9.3.1;7.3.1 Access to the tricuspid valve;137
9.3.2;7.3.2 Repair technique;139
9.4;7.4 Closure of the ASD;139
9.4.1;7.4.1 Technical considerations;140
9.4.2;7.4.2 Closure of the ASD;140
9.5;7.5 Excision of left atrial tumors;142
9.5.1;7.5.1 Theoretical remarks;142
9.5.2;7.5.2 Practical performing;143
10;Index;144

Über Autor(innen)

Krakor, Ralf
Ralf Krakor, Klinikum Dortmund, Deutschland

Ralf Krakor, Klinikum Dortmund, Deutschland